A review of dehydroepiandrosterone (DHEA).

Dehydroepiandrosterone (DHEA) is quantitatively the most abundant hormone in humans and mammals, with a wide variety of physiological effects, including major regulatory effects upon the immune system. Two of the most striking aspects of DHEA are a steady decline in DHEA with age and a significant deficiency in DHEA in patients with several major diseases, including cancer, atherosclerosis, and Alzheimer's disease. The hormone is secreted in a non-sulfated (DHEA) and sulfated form (DHEA-S). The two are apparently interchangeable, and it appears likely that its physiological effects are achieved by derivative molecules that have yet to be identified.

From Boys Town to Oliver Twist. Separating fact from fiction in welfare reform and out-of-home placement of children and youth.

Recent debate following the suggestion to place children of "welfare mothers" in "orphanages" illustrates the need to evaluate the relative goodness of residential care and to examine many of the basic assumptions underlying current welfare reform proposals. Nearly half a million children and youth are currently in government-funded out-of-home care in the United States. As custodians of this challenging population, child and youth care workers are neither parents nor therapists, but appear to perform both of these roles as "therapeutic parents." Two comprehensive and mature literatures--common factors of therapist efficacy and parental correlates of offspring psychopathology--provide theoretical and empirical support for this model of child and youth care. Current welfare reform proposals are evaluated in the context of the therapeutic parent model; assumptions about welfare mothers are also examined.

Modern medical electricity in the management of pain.

With the economics of medical care and the history of electrotherapeutics firmly in mind, one should seek treatments that are efficient and effective. There is no question that relief of the symptom of pain must be a primary focus of treatment, whether or not a specific pathology is known. Electric devices may be justifiably used for their placebo effects, if the cost is reasonable, because side effects are minor and infrequent. Research shows specific neurochemical effects of several electrotherapeutic devices, supporting the notion that specific therapeutic effects exist in addition to placebo effects. Passage of time and further research will determine which of the current techniques and devices will find their way into future similar articles or monographs.

Recent advances in migraine management.

Migraine periodically disables millions of Americans and thus has a significant economic impact on society. Successful treatment of migraine requires that the physician understand the pathophysiology underlying migraine and educate the migraineur in the management of this chronic pain syndrome. Recent advances in the receptor biochemistry of serotonin have given important insight into the mechanisms of migraine pain and treatment. An understanding of these mechanisms has resulted in treatment strategies that address the mechanism of headache control rather than just symptom control. Advances in pharmacologic therapy include a newly developed highly selective serotonin agonist called sumatriptan, which appears to be a promising addition to the armamentarium of abortive migraine treatments. Further data correlating the role of daily analgesics and ergotamines in transforming episodic migraine into chronic daily headache represent another significant advance in migraine management. Clinical trials of sumatriptan are reviewed, and the role of daily analgesic and ergotamine use is discussed in relation to advances in migraine pathophysiology and available demographic data on migraine.

Thermography and the sensory dermatome.

The basic neuroanatomic and physiologic aspects of the sympathetic outflow to the limbs are reviewed and correlated with the somatic sensory dermatomes. The recent literature is considered. A thermocouple thermometer was used to test 30 normal patients and 87 patients with clinically proven nerve root lesions. Thermographic imaging of the sensory dermatome is not plausible, and thermography is not recommended for clinical documentation of painful conditions of the neck, back, or limbs.

Management of acute pain in trauma.

In acute pain, TENS, ice packs, and a calm, reassuring attitude and voice are useful in reducing pain. Narcotic requirements can be reduced, and chronic pain may be prevented. Complications such as paralytic ileus and atelactasis can also be reduced. These techniques can be used in the emergency ward, the recovery room, and the doctor's office.

Facet denervation in the management of back and sciatic pain.

Back pain, with or without sciatic radiation, may come from a number of anatomical sites. Radiofrequency facet denervation suggests that a majority of patients seem to have pain referred from distress of the facet joints or the sacro-iliac joints. In those patients who are properly selected and have not had previous surgical treatment, radiofrequency denervation of the appropriate facet joints yields partial to total relief of pain in 82% of cases. The technique for doing this procedure and for selection of patients must be followed very closely but in over 800 patients surveyeyed for this report no neurologic complications have been reported. Facet denervation, when indicated, is proposed as a safe alternative to either chemonucleolysis or surgery.